Doctors Debunk Five Myths About Brain Metastases

Neurosurgeons recommend that brain metastasis count should not guide treatment for patients who need personalized care

(RxWiki News) New medical research continually contributes to how physicians treat their patients. As new information becomes available, older practices can become obsolete.

A committee of experts is seeking to reject five myths associated with the brain metastases, or cancers that have spread to the brain, that can lead to poorer care.

The committee's recommendations address topics including radiation treatment, the importance of early detection and tumor analysis.

"Consult a neurologist about brain cancer screening and treatment options."

Douglas S. Kondziolka, MD, MSc, FRCSC, vice chair of clinical research and director of the Gamma Knife Program in the department of neurosurgery at NYU Langone, was the lead author of this article.

“We are in an era of personalized medicine and we need to begin thinking that way,” Dr. Kondziolka said in a prepared statement.

According to Dr. Kondziolka and colleagues, the first misconception is that all cancer tumor cell types act the same way once spread to the brain. The authors called that an “oversimplification,” as brain metastases behave differently depending on whether they originate in the lung, breast or skin, for example. That variation can affect how the cancer would respond to chemotherapy or radiation.

The second myth addressed in the article is that the number of brain metastases is the best guide for treatment. The authors argued that relying only on number of tumors “can wrongly limit treatment options.” Instead, doctors should consider the size and scope of tumors rather than total number, according to the article.

The third myth is that all brain metastases suggest the presence of undetectable micrometastases, or very small tumors. The authors argued that’s not the case, and aggressive treatment of tumors can improve tumor control and patient survival.

The fourth misconception is that whole brain radiation (WBR) is not appropriate because it may cause brain damage if a patient lives long enough. Instead, the authors recommended that the risks and benefits of WBR should be weighed for each patient.

The authors also noted that studies on the impact of WBR on brain function are being conducted.

The final myth covered is that most brain metastases cause clear symptoms, making regular screening unnecessary. The authors found that modern screening methods allow for earlier detection, and subsequent treatment, before symptoms start.

The authors called for “fresh thinking and new critical analyses” in a joint statement that urged focus on “why some patients with a given primary cancer develop brain tumors and others do not.”

Input for these recommendations came from physicians and specialists from the Henry Ford Health System, University of Maryland Medical Center, the Cleveland Clinic and Harvard Medical School.

The committee's recommendations were published as a special article in the July issue of the peer-reviewed journal Neurosurgery.

Review Date: 
June 26, 2014